Gould J S, Shi S M
Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee 53226, USA.
Clin Orthop Relat Res. 1995 May(314):26-36.
Microsurgical procedures for coverage of foot and ankle defects now are undertaken with a better understanding of biomechanical requirements, and concern for durability, aesthetics, donor site morbidity, and shoe fit. Well-contoured muscle flaps including the latissimus dorsi, rectus abdominis, and gracilis muscles frequently are used along with thin cutaneous flaps, especially from the lateral arm. When good local options are absent and exposed nerves, tendons, and bone, and surgical hardware are present, acute free flaps and delayed primary procedures are done frequently with excellent success rates (> 90%). Surgical adjuncts and pedorthic devices are used readily to enhance functional outcomes and to resolve shoe fitting and tissue breakdown problems. Free tissue transfers for foot and ankle coverage defects have reached state-of-the-art status, having been refined significantly to resolve many earlier problems.
目前，在进行用于覆盖足踝部缺损的显微外科手术时，人们对生物力学要求有了更好的理解，并关注耐用性、美观性、供区并发症以及鞋的适配性。轮廓良好的肌皮瓣，包括背阔肌、腹直肌和股薄肌，经常与薄皮瓣一起使用，尤其是来自上臂外侧的皮瓣。当缺乏良好的局部选择且存在暴露的神经、肌腱、骨骼和外科植入物时，急诊游离皮瓣和延期一期手术经常进行，成功率很高（>90%）。手术辅助装置和足部矫形器械被广泛用于提高功能效果，并解决鞋的适配和组织破损问题。用于覆盖足踝部缺损的游离组织移植已达到先进水平，经过显著改进以解决许多早期问题。
